Pregnancy-Related Acne: Review and Clinical Tips

Acne vulgaris commonly affects women of childbearing age, but treating it during pregnancy raised safety concerns owing to risks associated with certain medications. Hormonal and physiological changes during pregnancy often trigger inflammatory acne lesions.

Women under 25 years of age, those with a higher body mass index, irregular menstrual cycles, or polycystic ovary syndrome were more likely to develop acne during pregnancy. Up to 43% of pregnant women experienced acne, with lesions often spreading beyond the face to the chest and back. Among women with a history of acne, one-third had a relapse after a period without symptoms, while two-thirds of those with ongoing acne saw worsening during pregnancy.

Safe and effective treatment for acne in pregnant women remained essential. In 2015, the U.S. Food and Drug Administration (FDA) revised its pregnancy safety classification system to guide treatment decisions better.

Several topical treatments were used for acne. Benzoyl peroxide is commonly recommended as a first-line option, either alone or in combination with other agents, for mild to moderate acne. Salicylic acid was considered a second-line option and appeared to be safe in low concentrations and when applied to limited areas.

Glycolic acid has limited safety data during pregnancy; however, in vitro studies have shown systemic absorption rates of up to 27%, depending on the product's pH, concentration, and duration of use. Clindamycin phosphate was effective and well tolerated for mild to moderate acne, and erythromycin was considered safe during all trimesters.

Isotretinoin was the most effective option for moderate to severe acne, offering the potential for long-term clearance. However, it was contraindicated during pregnancy due to its known teratogenic effects.

(Source: Cutis vol. 113,1 (2024): E26-E32. https://pubmed.ncbi.nlm.nih.gov/38478945/)